Adam Cairns

Over the years, I’ve interviewed lots and lots of public sector executives. Often they’re worried about how they will sound when an interview is written up and they give only answers that could be considered safe.

Adam Cairns, Chief Executive of the Cardiff and Vale University Health Board, is a breath of fresh air.

“I actually went to university to do Law because I really believe in justice as a principal, but it didn’t take me very long to work out that law has very little to do with justice unfortunately,”he says, top button undone and sitting relaxed in a chair. “So, I decided that that wasn’t for me. I finished the degree and I was going to be a poet. I was busy writing and publishing, and that’s what I thought I was going to do, but I needed to earn a crust.”

Around this time, Cairns saw an advert for the health service graduate training programme

“There was this bloke with a beard pointing at this hospital sign and I thought ‘well, how difficult can this be?’so I joined up and very quickly discovered it is fascinating, totally fascinating, and fully engaging,”he says laughing lightly.

What Cairns seems to find most interesting is that everything that happens in life happens at the hospital and in the health system.

“You’ve got all of life –you’ve got literally everybody from the bottle washer to the neurosurgeon. You’ve got every kind of individual you can think of coming through our doors every day. The great kind of wash of humanity and all the stories and all of the complexity and interest that that brings is interesting,”he explains.

The sentiment seems fitting for a person who started out as a law graduate with a tendency towards the poetic arts.

“Fundamentally, this is about you and I as individuals, our most intimate concerns, our anxieties about the future, what we hold to be important – and bringing all that together is very very complex. The world that we work in is a world of risk and complexity,”Cairns continues. “What’s interesting is understanding how all of that complexity can be worked with so that we keep it safe. So many things could go wrong. Every part of the chain is important.”

And the chain that Cairns is in charge of is ultimately a very complex one: There are 15,000 people in the Cardiff and Vale University Health Board –and those are just the employees. Couple that with a budget of £1.1 billion and an ageing population with an increasing number of lifestyle issues and as Cairns points out, a society that expects everything immediately.

“We are confronting, like everybody else is in every other health system, huge challenges at the moment. Everybody has to play a part and there is a huge cultural aspect to what we do. For example, one of the things that we are focussing a lot on at the moment is this idea that the world is imperfect –it’s not a machine, there isn’t a manual and you work on the world one conversation at a time,”Cairns says in exactly the kind of un-executive manner that makes him so refreshing. “If you want to make an operation go smoothly or if you want to have a good flow in your organisation –patients coming in at one end, going out the other –you have to figure that out. It doesn’t just happen.”

Cairns gives the example of a misunderstanding between nurses and porters. The nurses were frustrated because when they had a patient ready to be admitted, the porters were late and patients were left hanging about.

“I asked whether or not the porters had been engaged in that conversation and they said no because they didn’t really think they are up to it, and that’s the problem,”Cairns explains. “So I got to see the porters and ask ‘What’s your take?’, and they said ‘Well the thing is that we are very very busy and when we get a call from the A&E department, we go down there and more often than not the patient isn’t ready, so we go and do another job.’”

When Cairns went back to the nurses with the porter’s response and asked why they were often called before they were ready, the nurses explained that they called early because the porters were always late.

“That story tells us that it’s all about people and how they work together and there isn’t one answer or one solution –it’s more about the relationship, taking responsibility, people feeling that they can own their own situation,”he says.

As well as patient care though, Cairns is where the buck stops when it comes to the medical education part of the organisation. And that is quite a significant part: 54% of the total research output for the NHS in Wales comes from the Cardiff and Vale University Health Board.

“One really great example of medical education: about 18 months ago one of the very good doctors here got engaged in a conversation with third year medical students. They were just at that point in their training where they were beginning to emerge onto the wards and they felt completely useless, completely overtopped. They weren’t fish nor fowl, and it was all very heavy, scary,”Cairns says. “Anyway, through the process of conversation, what somebody suggested was ‘Why don’t we ask at the end of every single conversation we have with every patient, “Is there something that I can do for you?”’

Initially, the fear of many health professionals was that people would ask questions about their mortality. However, that turned out to be a lot more ethereal than the reality:

“So what they did is they set up a study to examine what it would be that patients would ask if you ask them that question, and remarkably, maybe predictably, but very powerfully, what they discovered was that most of the time, patients simply said ‘yes, thank you’, ‘I need to go for a wee’, or ‘can you just pass me some water?’, or ‘can you just move me up the bed a little bit?’,”Cairns continues. “That’s a very powerful proposition because I think that we’re thinking –‘how can we turn that notion that anybody whoever you are, if we all complete every single conversation that we have with the patient and say, ‘and just before I go, is there anything I can do right now?’- what a fantastic transformational moment that will be, if we can just get that being what everybody does.”

Finally, Cairns has something to say about the larger issue managing healthcare in a complex world.

“I think we need many more conversations but I think some of the solution is going to be about encoding more of what we do into agreed responses which draw on the evidence and guide and direct people to the right responses, always allowing for the fact that in the end we also want people to look outside of those when it is necessary,”he says. “I think the anaesthetists as a group are a very good example of this because it is a very broad discipline, with very different settings and very different aspects to what they do. Engaging with that complexity and working out ‘what are the kinds of things we can do differently to manage that more effectively?’is a puzzle for everybody. If we think as managers that we’ve got or should have or are entitled to have a monopoly on what do we do about that then it is completely misplaced because the world we are in needs everybody to engage with it because it is becoming so complex.”